The relationship between bile acids levels and the prognosis of patients with diabetes on maintenance hemodialysis: a retrospective study

Figures & data

Figure 1. Flowchart of the patients included in this study.

Figure 2. The optimal cut-point value of bile acids.

Figure 3. Dynamic HR changes with bile acids levels. HR, dynamic risk ratio.

Table 1. Baseline clinical features of enrolled 387 patients on MHD with DM.

Variables	All (n = 387)	Lower BA(n = 172) (≤3.5μmol/L)	Higher BA (n = 215) (>3.5μmol/L)	P-value
BAs (μmol/L)	4.00 (2.30 − 6.20)	1.40 (2.20 − 2.70)	4.50 (5.80 − 8.20)	<0.001
Age (years)	61.00 (50.00 − 72.00)	60.00 (49.00 − 71.75.00)	62.00 (50.00 − 73.00)	0.354
Gender (male, %)	227 (58.7)	98 (57.0)	129(60.0)	0.548
BMI (kg/m^2)	22.34 (16.96 − 24.62)	22.80 (19.76 − 25.38)	21.97 (19.76 − 25.38)	0.094
Hypertension [n (%)]	369 (95.3)	165 (95.9)	204 (94.9)	0.809
e-GFR (ml/min/1.73m^2)	4.78 (3.74 − 6.62)	4.74 (3.78 − 6.70)	4.79 (3.74 − 6.49)	0.756
Serum albumin (g/L)	34.90 (30.40 − 39.10)	34.40 (29.70 − 38.20)	35.50 (31.28 − 39.50)	0.018
Hemoglobin (g/L)	82.00 (68.00 − 98.00)	82.00 (68.00 − 98.00)	82.00 (69.00 − 97.25)	0.943
HbA1c (%)	7.89 ± 1.99	7.76 ± 2.25	8.02 ± 1.67	0.411
Blood glucose (mmol/L)	6.45 (5.38 − 8.75)	6.33 (5.38 − 8.76)	6.59 (5.38 − 8.75)	0.513
Triglyceride (mmol/L)	1.48 (1.08 − 2.21)	1.49 (1.06 − 2.14)	1.46 (1.08 − 2.25)	0.725
Total cholesterol (mmol/L)	3.79 (3.18 − 4.56)	4.01 (3.28 − 4.71)	3.68 (3.00 − 4.50)	0.029
LDL-c (mmol/L)	2.15 (1.55 − 2.80)	2.31 (1.63 − 2.88)	1.98 (1.51 − 2.64)	0.012
HDL-c (mmol/L)	1.16 (0.88 − 1.40)	1.14 (0.89 − 1.40)	1.16 (0.88 − 1.68)	0.900
Serum calcium (mmol/L)	2.04 (1.83 − 2.18)	2.06 (1.90 − 2.18)	2.01 (1.81 − 2.18)	0.04
Serum phosphorus (mmol/L)	1.89 (1.55 − 2.31)	1.85 (1.48 − 2.30)	1.91 (1.59 − 2.92)	0.344
Parathyroid hormone (ng/ml)	249.00 (147.00 − 421.00)	230.00 (1140.25 − 438.50	253.00 (154.00 − 415.25)	0.709
C-reactive protein (mmol/L)	4.00 (1.40 − 16.00)	4.65 (2.00 − 17.80)	3.55 (1.00 − 15.00)	0.259
Death (n, %)				0.118
All-causes of death	84 (21.7%)	49 (28.5)	35 (16.28)	0.130
Cardiovascular death	49 (12.7)	29 (16.7)	20 (9.3)	0.261

BAs: bile acids; e-GFR: estimated glomerular filtration rate; LDL-c: low-density lipoprotein cholesterol; HDL-c: high-density lipoprotein cholesterol; MHD: maintenance hemodialysis; DM: diabetes mellitus.

Table 2. Correlations of BAs levels with different clinicopathological data.

Variables	Correlation coefficient	P-value
Age (years)	0.068	0.182
Gender (male, %)	−0.069	0.178
BMI (kg/m^2)	−0.067	0.191
Hypertension [n (%)]	0.032	0.531
e-GFR (ml/min/1.73m^2)	−0.048	0.344
Serum albumin (g/L)	0.054	0.288
Hemoglobin (g/L)	−0.057	0.260
HbA1c (%)	−0.416	0.083
Blood glucose (mmol/L)	0.080	0.118
Triglyceride (mmol/L)	0.013	0.795
Total cholesterol (mmol/L)	−0.102	0.046
LDL-c (mmol/L)	−0.110	0.030
HDL-c (mmol/L)	−0.045	0.377
Serum calcium (mmol/L)	−0.107	0.036
Serum phosphorus (mmol/L)	0.039	0.443
Parathyroid hormone (ng/ml)	−0.001	0.983
C-reactive protein (mmol/L)	−0.002	0.963

BAs: bile acids; e-GFR: estimated glomerular filtration rate; LDL-c: low-density lipoprotein cholesterol; HDL-c: high-density lipoprotein cholesterol.

Figure 4. The relationship between varying levels of BAs and all-cause death in MHD with DM patients.

Figure 5. The relationship between varying levels of BAs and cardiovascular death in MHD with DM patients.

Table 3. Associations between BAs level and all-cause death in MDH with DM.

	Hazard ratio (95% Confidence interval)
	Lower BA(n = 172) (≤3.5μmol/L)	Higher BA (n = 215) (>3.5μmol/L)	P-value
Unadjusted	1	0.59 (0.38-0.91)	0.01
Model 1^a	1	0.53 (0.34-0.83)	0.005
Model 2^b	1	0.51 (0.33-0.81)	0.004
Model 3^c	1	0.55 (0.35, 0.87)	0.01

Model 1^a:adjusted for baseline age, gender, BMI; Model 2^b: adjusted for covariates in model 1 plus dialysis frequency and e-GFR; Model 3^c: adjusted for covariates in model 2 plus hemoglobin, serum albumin, parathyroid hormone, C-reactive protein. BAs: bile acids; e-GFR: estimated glomerular filtration rate; MHD: maintenance hemodialysis; DM: diabetes mellitus.

Data availability

All datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.